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J Matern Fetal Neonatal Med. 2017 May;30(9):1114-1123. doi: 10.1080/14767058.2016.1205024. Epub 2016 Jul 17.

Cesarean myomectomy trends and controversies: an appraisal.

Author information

1
a Clinic of Gynecology and Obstetrics, Clinical Center of Serbia , Belgrade , Serbia.
2
b School of Medicine, University of Belgrade , Belgrade , Serbia.
3
c International Translational Medicine and Biomodeling Research Group, Department of Applied Mathematics Moscow Institute of Physics and Technology, Moscow State University, Russia.
4
d Department of Obstetrics & Gynecology , Santa Maria Hospital, GVM Care & Research , Bari , Italy.
5
e Clinic of Gynecology and Obstetrics "Narodni Front" , Belgrade , Serbia , and.
6
f Division of Experimental Endoscopic Surgery , Imaging, Technology and Minimally Invasive Therapy, Department of Obstetrics and Gynecology Vito Fazzi Hospital , Lecce , Italy.

Abstract

OBJECTIVE:

Although the first report on cesarean myomectomy (CM) was a century ago, the management of a myomectomy during a cesarean section (CS) remains controversial. The objective of this study is to provide the latest data on this topic regarding the techniques and complications of CM.

METHODS:

The authors consulted the most important scientific databases investigating the indications and contraindications for CM, the operational techniques, benefits and complications.

RESULTS:

CM provides the benefits of two surgeries in one laparotomy, avoiding the risks of repeated anesthesia and relaparotomy. Nevertheless, in some patients, CM may be associated with increased morbidity and, in such cases, an interval myomectomy might be a safer option. Myomas compromising fetal extraction and uterine incision and/or suturing should be preferably enucleated during CS. CM is generally considered relatively safe in cases of anterior wall myomas, subserous and pedunculated myomas, particularly if a myomectomy is feasible without additional hysterotomy. Multiple myomas, deep intramural, fundal and cornual myomas and posterior uterine wall myomas are associated with more surgical complications during CM.

CONCLUSIONS:

With increasing reports in favor of CM, the risk-benefit ratio should be still evaluated with randomized controlled trials, in order to achieve more data on CM.

KEYWORDS:

Cesarean myomectomy; cesarean section; complication; myoma; technique

PMID:
27328626
DOI:
10.1080/14767058.2016.1205024
[Indexed for MEDLINE]

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